Scientific Article Review:

Sugar Alcohols, Caries Incidence, and Remineralization of Caries Lesions: A Literature Review

Published In: International Journal of Dentistry
Publication Year: 2010

Study Design

This article is a literature review summarizing clinical, laboratory, and animal studies on the effects of sugar alcohols (e.g., xylitol, sorbitol, and erythritol) on dental caries prevention and remineralization.

Funding Sources

The study does not specify its funding sources.

PICO Framework - what was studied and how?

Population:
Individuals at varying levels of dental caries risk, including children and adults, with primary or permanent teeth.

Intervention:
Use of sugar alcohols like xylitol, sorbitol, and erythritol in various vehicles (e.g., chewing gum, candies, dentifrices).

Comparison:
Use of sucrose or other non-cariostatic sugars, fluoride-only treatments, or no intervention.

Outcomes:
Reduction in caries incidence and enhancement of enamel or dentin remineralization.

In Paragraph Form:
This review investigates the use of sugar alcohols, particularly xylitol, in reducing dental caries compared to conventional sugars and fluoride. The outcomes analyzed include caries prevention and enamel or dentin remineralization, across diverse populations, using a variety of delivery mechanisms.

Inclusion and Exclusion Criteria

Inclusion Criteria:

• Clinical trials, laboratory studies, and animal research on sugar alcohols and caries prevention.
• Studies analyzing remineralization effects of sugar alcohols.

Exclusion Criteria:

• Studies focusing solely on fluoride without sugar alcohol comparisons.
• Research not measuring caries incidence or remineralization outcomes.

Demographics and Study Summary

The review synthesizes data from multiple studies:

• Subjects ranged from children to adults, with caries risks varying across geographies.
• Cohorts included intervention groups using sugar alcohols and comparison groups using sucrose or fluoride.
• Study durations spanned weeks to years.

Primary Outcome Variables and Results

Primary Outcomes:

1. Reduction in dental caries incidence.
2. Enhanced enamel and dentin remineralization.

Key Results:

• Caries Reduction: Xylitol reduced caries by up to 85% in some studies, compared to sucrose or no intervention. Preventive fractions (PF) for caries reduction were reported as follows:

  • Xylitol: 58.7% (95% CI: 35.4–81.9).
  • Sorbitol: 20.0% (95% CI: 12.7–27.3).

• Remineralization: Xylitol demonstrated superior remineralization compared to sucrose and sorbitol. Statistically significant effects included reduced lesion depth and increased enamel hardness (p < 0.05).

Conclusions

The review concludes that sugar alcohols, particularly xylitol, significantly reduce caries incidence and promote enamel and dentin remineralization. Xylitol also offers synergistic effects when combined with fluoride, making it a valuable component of caries prevention strategies.

Discussion

Strengths:

• Comprehensive inclusion of multiple study types and methodologies.
• Detailed analysis of sugar alcohol properties and biochemical mechanisms.

Weaknesses:

• Limited evidence directly comparing erythritol and xylitol.
• Some included studies had small sample sizes or short durations.

Citation

Mäkinen KK. Sugar alcohols, caries incidence, and remineralization of caries lesions: a literature review. Int J Dent. 2010;2010:981072. https://pubmed.ncbi.nlm.nih.gov/21318195/

Visual Aids

Simple Chart: Preventive Fractions for Caries Reduction